23D2183051 CLIA NUMBER - GRASS LAKE SURGERY CENTER, LLC

Laboratory Demographics

CLIA Number: 23D2183051

Facility Name: GRASS LAKE SURGERY CENTER, LLC

Facility Address:
3800 CENTENNIAL BLVD
GRASS LAKE, MI
ZIP 49240
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Facility Phone Number: 517 701-3100

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1790306991

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	23D2183051
LAB Type	Ambulatory Surgery Center
Facility Name	GRASS LAKE SURGERY CENTER, LLC
Street	3800 CENTENNIAL BLVD
City	GRASS LAKE
State	MI
ZIP	49240
Phone	517 701-3100
CertificateType	4
CertificateEffectiveDate	4/29/2024
CertificateExpirationDate	4/28/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024